National Journal of Health Sciences
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Perspective on Polio Eradication - What is the Issue?
No full textAbstract: WHO proclaims polio a social and community health crisis. Global Polio Eradication Initiative (GPEI) was resolved to make world polio-free and had contributed significantly to eradicate polio from 1000 cases per day in 1988 to 8 per year in 2017 [1, 2]. However, this disease is still widespread in Afghanistan and Pakistan, due to number of problems, an important topics for debate, which poses great threat to the re-emergence of the deadly disease worldwide. Yet, these two countries potential risk should not be taken lightly, as in the seam of 2002 to 2005, reinvigoration and re- entry of polio occurred in 21 countries, with the increase in global migration of people [3]. Till August 13th 2018, 17 WPV1 cases have been reported (thirteen in Afghanistan and four in Pakistan), compared with 22 cases in endemic countries reported in 2017, and its transmission is still continue in Pakistan, as being isolating from the wastewater samples [4]. Therefore, Utmost suggestions are made to improve the status of polio from the remaining two countries as well, by approaching to it through new different strategies and ideas focusing current experiences and issues to eradicate polio as soon as possible
Workplace Violence against Nurses Working in Emergency Departments at Public Hospitals Lahore
No full textAbstract: Background: Work place violence is an alarming and devastating issue worldwide particularly in the emergency departments. Incident of work place violence is common towards nurses in health care settings. Nurses are more prone to workplace violence due to lack of respect towards nursing profession in Pakistani society and the nature of work performed by the nurses. Objective: The main purpose of this study was to assess the prevalence of work place violence including physical and non physical and bring awareness about work place violence among nurses at the emergency departments of health care systems. Methodology: A cross sectional descriptive survey was performed to assess the prevalence of work place violence at tertiary care hospitals of Lahore. A convenient sample of n = 147 was used to collect the data. A structured standardized adopted questionnaire was used to collect data. The questionnaire consisted demographic, physical and non physical variables. The data was collected from Jinnah and services hospital Lahore. The data was analyzed on SPSS version 21. Results: It was found that 77.55% stated that they are not exposed to physical violence last 12 months, 13.6% said once, 7.48% said 2-3 times and 1.3% stated they have been exposed 4-5 times during last year. On the other hand the participants exposed to Nonphysical violence in last12 months,12.93% stated that they are not exposed to physical violence last 12 months, 25.85% said once, 40.82% said 2-3 times and 19.73% stated they have been exposed 4-5 times during last year. Most recent physical incident in which 10.20% of incidents were happened at resuscitation room 2.04% at waiting room and 10.20% in treatment room. The most recent nonphysical incident in which 38.10% of incidents were happened at resuscitation room 0.68% in triage 12.24% at waiting room and 37.41% in treatment room 0.68% in other places. Conclusion: The physical violence prevalence was found less that the nonphysical violence, but Physical violence is more threatening than the nonphysical violence
Scientific Basis of Dealing with the Cost Issues in Routine Oncology Practice in Low & Middle Income Countries
No full textCancer burden is increasing day by day in our Low and Middle Income Countries (LMIC) A practicing clinician faces the issue of cost of treatment in almost all patients who approach him or her for clinical consultation . More than often, the clinician has no formal training in cancer service development. Establishment of modern oncological services is dependent on financial resources available to the professionals who sit across an extra-large sized rectangular table and try to get the best out of the money pot. Some skeptics call it beauty out of the junkyard. The allocation of funds is dependent on the feasibility studies done by thehealthcare economists .These wise guys seem to know a lot about the health of a nation, but many health care professionals have some reservations about their understanding of the practical knowledge of day to day managerial and clinical problems, faced by the person sitting at the receiving end
Incidence of Drug Induced Akathisia with Aripiprazole and Risperidone: A Comparative Study
No full textAbstract: Background: Clinicians have voiced concerns over the possibly high frequency of Akathesia that occur with Aripiprazole use, however, the existing literature is not consistent with these observations. Aim: To compare the frequency of Akathesia occuring with Aripiprazole and Risperidone. Method: A total of 60 patients were included in the study. Patients fulfilling the inclusion criteria were then randomly assigned into 2 groups of 30 patients each. One group is given Aripiprazole (10 mg) and the other is prescribed Risperidone (2mg). Patients of both groups were re-evaluated on the 7th day after the start of the medication and were screened and calibrated for Akathisia using the Barnes Akathisia Rating Scale (BARS) with a cut off value of 2 or more on global assessment confirming the presence of Akathisia. A sub-group, not having akathesia on 7th day was screened again on 21st post treatment day. Result: The Akathesia assessment done on the 7th day revealed the presence of Akathesia in two (6.67%) patients getting Aripiprazole 10 mg and one patient (3.34%) in the group receiving Risperidone 2 mg. Furthermore, no patients in either of the sub-groups had Akathesia when assessed on 21st post treatment day. Conclusion: The frequency of Akathesia occuring with Aripiprazole is comparable to that with Risperidone and is considered low
Frequency of Nucleophosmin1 Gene Mutation (NPM1) in Acute Myeloid Leukemia - A Single Center Experience
No full textAbstract: Introduction: NPM1 mutation is considered to be an important event in the process of leukemogenesisas it affects the p53 tumor suppressor pathway in the form of frame shift mutation. It is thought to provide a favorable outcome to the disease especially in the absence of FLT3 mutation.This study was conducted to find out the frequency of NPM1 mutations in patients with AML in Pakistani population. Materials & Methods: This was a descriptive cross sectional study conducted for a time period at the National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi. Study subjects’ demographics including age, gender, presence and duration of the symptoms. Diagnosis was made on the morphology of blood and/or bone marrow samples in accordance to the revised WHO classification of myeloid neoplasms, 2016. All the patients were treatment naive at the time ofenrollment into the study. Sanger sequencing was performed to detect NPM1 mutation. Results: Out of 100 patients who were enrolled in the study, 60% were males. The mean age of patients was 38.9 years (range: 8yrs - 60yrs). NPM1mutation was detected in 14(14%) patients of the total AML cases with equal presence in both genders. According to the WHO classification 2016, NPM1 was found in 3(3%) in AML without maturation, 4(4%) in AML with maturation, 3(3%) in acute promyelocytic leukemia and 3(3%) in acute myelomonocytic leukemia. Conclusion: NPM1 was detected in 14% cases of AML in our study. The presence of the NPM1 mutationhas a considerable impact on the prognosis of the disease as it may help in the tailoring of the future treatment of the AML patients particularly those with normal cytogenetics
Health Care Delivery System of Pakistan and Bangladesh: A Comparative Analysis
No full textAbstract: Health care delivery system is fair distribution, organization, and arrangement of health resources that serves best for any country’s population efficiently and effectively for the achievement of organizational goals. Health care services are the multiple services providing to an individual, families, and communities by health care providers who are skilled to prevent disease, promote health, cure illness for the purpose of maintaining and restoring good health. Human development and economic solidarity can be increased ultimately due to better health that labor of a country. Productive human capital resources and healthy labor force can be achieved by planned healthcare services by the government for its people. Worldwide, health regions contrasts from country to country, it depends on how much costs on health is been efficiently utilized. The primary contributors in health care services are private health sectors, donors, out of pocket expenditures in the most of developing countries which may increase human capital and economic growth of the country as, public health sectors remains deprived due to structural fragmentation, lack of resources, and functional inabilities. In this article we discuss about the healthcare delivery system of Pakistan versus Bangladesh such as organizational structure, analysis of both the healthcare systems, and some recommendations to improve healthcare reform and its application
Immune Thrombocytopenia
No full textImmune thrombocytopenia (ITP) is characterized by immune mediated platelet destruction in the body. Autoantibodies are formed directed against platelet surface membrane glycoproteins; antibody coated platelets are removed from circulation by the macrophages of reticuloendothelial system in spleen, liver and other parts of the body [1]. When the rate of destruction of platelets exceeds the rate of platelet production in the bone marrow, platelet count starts to decline resulting in thrombocytopenia. The degree of thrombocytopenia may vary; this condition runs a relapsing and remitting course
An Overview of Effects of Carbonated Drinks
No full textAbstract: Soft drinks are those drinks which do not contain alcohol. These soft drinks are either carbonated or non-carbonated soft drinks. Carbonated soft drinks are consumed widely across the globe. Today, when people are becoming more health conscious, concerns are being raised regarding the impact of carbonated soft drinks on health. When discussing the effects of carbonated soft drinks on health carbon dioxide, phosphoric acid and sugar are of main concern. Most carbonated beverages have acidic pH which results in gastroesophageal reflux disease (GERD) like symptoms. The phosphoric solution in these beverages is powerful enough to cause human teeth to become soft. The caffeine present in colas is known to be a hazardous factor for osteoporosis. When taken after a period of dehydration, the sugar in these beverages is known to cause more renal injury then plain water. The sugar content in these beverages may lead to lipids production in the body and result in obesity, hypertension, non-alcoholic fatty liver disease (NAFLD), and pancreatic cancer. Hence, it is necessary to monitor diet and focus on natural and healthy beverages
A Severe Hypokalemia Case Due to Ectopic Acth Syndrome Secondary to Small Cell Lung Cancer
No full textAbstract: Ectopic adrenocorticotropic hormone (ACTH) syndrome is responsible about 15% of Cushing syndrome cases. Malignant tumors, such as, small cell lung cancer, gastric or bronchial carcinoids, pheochromacytoma, medullary thyroid cancer, are principle causes of ectopic ACTH secretion. Syndrome manifest with impaired glucose tolerance or overt diabetes, hypertension, hypokalemia and lipid disorders. Here we report a subject presented with severe hypokalemia due to ectopic ACTH syndrome, who was diagnosed with small cell lung cancer consequently. A sixty five year old man presented with severe hypokalemia. He was diagnosed with small cell lung cancer. Serum ACTH and cortisol levels of the subject were extremely high. Although chemotherapy initiated, he died due to respiratory failure. Radiologic studies should be ordered to rule out underlying tumoral developments in patients presenting with delirium and hypokalemia. Moreover, hyperglycemia in elderly without prior history of diabetes mellitus should be evaluated for malignant lesions and ectopic release of ACTH. 
Platelet Distribution Width is Associated with Type 2 Diabetes Mellitus and Diabetic Nephropathy and Neuropathy
No full textAbstract: Aim: Type 2 Diabetes Mellitus (T2DM) is one of the most important chronic conditions in the world that cause great economic burden on healthcare providers. Authors study novel inflammatory markers that derived from routine blood count tests in inflammatory conditions, such as T2DM. One of these parameters is platelet distribution width (PDW), which refers the size variability of circulating platelets. In present retrospective study, we aimed to compare PDW levels of T2DM patients to those with healthy subjects. We also aimed to compare PDW levels of diabetic subjects with and without chronic diabetic complications.Methods: Type 2 diabetic patients admitted to outpatient clinics between January and June 2018 were enrolled to the study.Results: The PDW of patients with T2DM (18.1 ± 0.9%) was significantly increased compared to the PDW of healthy control subjects (16.7± 0.5%). In subgroup analyze of patients with T2DM revealed that PDW and HbA1c levels of the patients with diabetic nephropathy were significantly elevated compared to the diabetic subjects without diabetic nephropathy (p < 0.001 for both HbA1c and PDW). Similarly, PDW and HbA1c levels of the patients with diabetic neuropathy were significantly elevated compared to the diabetic subjects without diabetic neuropathy (p < 0.001 for PDW and p = 0.01 for HbA1c). PDW was positively and significantly correlated with HbA1c (r = 0.63, p < 0.001) and fasting plasma glucose (r = 0.48, p < 0.001) levels. Conclusion: Elevated PDW should alert physicians for possible T2DM in otherwise healthy subjects. It may be useful in follow up of diabetic regulation and development of diabetic neuropathy and nephropathy in subjects with T2DM